This NIH-sponsored, multicenter randomized clinical trial is designed to compare the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) to total paracentesis for refractory ascites in cirrhotic patients. The effects of TIPS on the pathophysiology of portal hypertension will also be examined. Additional endpoints to be examined include cost of care, quality of life, diuretic doses, need for liver transplantation and nutritional status.